Transcript Sexual Health as You Age Maximizing the enjoyment of sex throughout your lifetime. Presented by: Kenneth E.

Sexual Health as You Age
Maximizing the enjoyment of sex throughout
your lifetime.
Presented by: Kenneth E. Smith, MD &
Elmer Pineda, MD
Let’s Talk About It
• Who gives a hoot?
• According to a New England
Journal of Medicine
2009 study
– 65-74 year olds-53%
– 75-85 year olds-26%
Sexual Health
• When you're in the mood, it's
a sure bet that the last thing
on your mind is boosting your
immune system or maintaining
a healthy weight. Yet good sex
offers those health benefits
and more.
• Sex does a body good in a
number of ways. The benefits
aren't just anecdotal or
hearsay -- each of these health
benefits of sex is backed by
scientific scrutiny.
Sex Boosts Self-Esteem
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"Boosting self-esteem was one of 237
reasons people have sex, collected by
University of Texas researchers and
published in the Archives of Sexual
Behavior.
That finding makes sense to Gina
Ogden, PhD, a sex therapist and
marriage and family therapist in
Cambridge, Mass., although she finds
that those who already have selfesteem say they sometimes have sex
to feel even better. 'One of the
reasons people say they have sex is
to feel good about themselves,' she
tells WebMD. 'Great sex begins with
self-esteem, and it raises it. If the sex
is loving, connected, and what you
want, it raises it.
Sex Relieves Stress
• "A big health benefit of sex is
lower blood pressure and overall
stress reduction, according to
researchers from Scotland who
reported their findings in the
journal Biological Psychology.
They studied 24 women and 22
men who kept records of their
sexual activity. Then the
researchers subjected them to
stressful situations -- such as
speaking in public and doing
verbal arithmetic -- and noted
their blood pressure response to
stress. Those who had intercourse
had better responses to stress
than those who engaged in other
sexual behaviors or abstained."
Sex Burns Calories
• "Thirty minutes of sex burns
85 calories or more. It may not
sound like much, but it adds
up: 42 half-hour sessions will
burn 3,570 calories, more than
enough to lose a pound. The
number of calories burned
during sex is about the same
as the number burned by
walking at 2 miles per hour.
• Doubling up on the 30 minute
sessions, you could drop that
pound in 21 hour-long
sessions."
Sex Improves Cardiovascular Health
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"While some older folks may worry
that the efforts expended during sex
could cause a stroke, that's not so,
according to researchers from
England. In a study published in the
Journal of Epidemiology and
Community Health, scientists found
that the frequency of sex was not
associated with stroke in the 914
men they followed for 20 years.
And the heart health benefits of sex
don't end there. The researchers also
found that having sex twice or more a
week reduced the risk of fatal heart
attack by half for the men, compared
with those who had sex less than
once a month."
Sexual Problems
Psychological Issues
• Stress
• Performance Anxiety
• Unresolved Relationship Problems
Physical Issues
• Age/Hormonal Changes
• Substances/Medication/Sleep/Fatigue
Sex-Drive Issue: Stress
• You may be the kind of
person who does many
things well when under
stress. But feeling sexy isn't
likely to be one of them. Job
stress, money troubles,
caring for a sick family
member, and other
stressors can decrease
libido. To keep your stress
levels in check, learn helpful
stress management
techniques or seek the
advice of a counselor or
doctor
Menstrual Cycle
• He wants it and you want to curl
up with a hot water bottle? This
comes down to a difference in
comfort—and squeamishness.
But using your period as a blanket
excuse is a missed opportunity to
talk about how you both feel.
• Bust out: If having sex during
your period isn’t your cup of tea,
he should respect that, but
intercourse isn’t your only option
those days. Also, showers do
wonders for messes. “Make
compromises and be generous,”
recommends Masini.
Menopause Symptom: Sex Problems
• Less estrogen can lead to vaginal
dryness, which may make
intercourse uncomfortable or
painful. Try using a water-soluble
lubricant. Libido may also change,
for better or worse, but many
factors besides menopause -including stress, medications,
depression, poor sleep, and
relationship problems -- affect sex
drive. Talk to your doctor if sex
problems occur -- don't settle for
a so-so sex life. And remember,
sexually transmitted diseases
(STDs) don't end with
menopause; "safer" sex still
counts.
Other Menopausal Treatments
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Other treatments include low-dose
birth control pills if you're perimenopausal; antidepressants, blood
pressure drugs, or other medications to
help with hot flashes; and vaginal
estrogen cream.
Hormone replacement therapy can
ease menopausal symptoms. Various
prescription products are available to
treat hot flashes and vaginal symptoms.
Some are also recommended to
prevent osteoporosis. The FDA
recommends taking the lowest dose
that helps, and only for the shortest
time because studies have linked longterm use of hormone replacement
therapy to a greater risk of heart
attacks, strokes, blood clots, and breast
cancer.
The Pros and Cons of Hormone
Replacement Therapy for Women?
Pros:
•
Prevents bone loss that can lead to osteoporosis
•
Relieves symptoms of menopause
•
Lowers risk of colon cancer
•
Lowers risk of vision loss that occurs when the
macula, the part of the retina at the back of the
eye that provides sharp, central vision,
deteriorates with age
Cons:
•
While HRT may help many women get through
menopause, the treatment is not risk-free.
Known health risks include:
•
An increased risk of Endometrial Cancer (if a
woman still has her uterus and is not taking
progesterone along with estrogen)
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Increased risk of blood clots
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Increased risk of stroke
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Increased risk of gallbladder disease
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Increase in blood pressure in some women
•
Increased risk of larger, more invasive breast
cancers (combination HRT only)
• Sex tonight? Sometimes you’re
legitimately not into it, but be
honest: Do you occasionally
make excuses to avoid making
love? In some long-term
relationships partners go on
auto-pilot, says Christina
Steinorth, psychotherapist and
author of Cue Cards for Life:
Thoughtful Tips for Better
Relationships. “They stop
checking in, touching one
another, talking.”This leaves
you feeling disconnected—
and
more apt to pull a get-out-ofsex card.
• Excuse: I’m too tired tonight.
• Raise your hand if you’re not
tired. Between jobs, kids and
housework, we’re all running on
empty. But careful you’re not
using “too tired” as shorthand for
“I don’t want to deal with you
right now,” says Steinorth.
• Bust out: First, sex usually
doesn’t take that much time away
from sleep (and you might sleep
better!). Second, if you really
mean there’s too much on your
mind, say so: “I’m occupied with
the bills/the bathroom leak/my
boss’s attitude.” Clearing the air
can clear the way for sex.
Great Sex Tip: Schedule Sex...Really!
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"'There's this powerful mythology that says
you should fall into each other's arms
spontaneously, with string music playing and
the sun setting in the West, and if that
doesn't happen there's something wrong
with you,' Castleman says. 'Nonsense. Real
life doesn't work that way.'
Rather than heightening the pressure to
perform ('It's now, or never!'), scheduling can
actually make sex more relaxing. You can
develop sensual rituals; make romantic
gestures in anticipation of your encounter.
You can give each other massages or take a
shower together.
Castleman says that scheduling sex also
eliminates conflict over desire differences.
'People say, 'What if I'm not in the mood?'
Well, one of the things about relationships is
that you sometimes make compromises. But
what astonishes people once they start
scheduling sex is that they can actually enjoy
it.'"
• Excuse: What's the point? I never
orgasm anyway.
• Ouch. Also: Yikes. “When you
write off the possibility of
enjoying sex, you aren’t giving
him an opportunity to improve
his skills as a lover,” says
Steinorth. And you’re selling
yourself short, too.
• Bust out: Imagine how you’d feel
if he told you that you didn’t ever
please him. You’d be upset, and
you’d want to know what to do to
make it better. Tell him. Your
silence (and belief that he should
just “know”) is doing no one any
favors.
Sex-Drive Issue: Unresolved Issues
• Unresolved relationship
problems are one of the
most common killers of sex
drive. For women in
particular, emotional
closeness is a major
ingredient in sexual desire.
Simmering arguments, poor
communication, betrayal of
trust, and other barriers to
intimacy can steer your sex
drive off the road.
Sex-Drive Issue: Alcohol
• A drink or two doesn't
always put you in the
mood. Alcohol famously
makes you feel less
inhibited about sex. But it
can also numb your sex
drive. And even if it
doesn't numb your sex
drive, inebriation can be a
turn-off for your partner.
All of this goes for
recreational drugs, too
Sex-Drive Issue: Smoking
Smoking causes erectile
dysfunction.
• If you want to smoke in
the bedroom, quit
smoking. It can cause
erectile dysfunction.
• For men in their 30s and
40s, smoking increases
the risk of erectile
dysfunction (ED) by about
50 per cent.
Sex-Drive Issue: Too Little Sleep
• If your sexual get-up-andgo is gone, maybe you're
getting up too early or
getting to bed too late. Or
maybe you have insomnia
or sleep apnea. Whatever
it is that's interfering with
your sleep, it's also
interfering with your sex
drive. Too little sleep
creates fatigue. Fatigue
saps sex drive.
Sex-Drive Issue: Medication
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Drugs commonly linked to libido loss include:
Antidepressants
Blood pressure medications
Antihistamines
Oral contraceptives (some studies show a
link; others don't)
Chemotherapy
Anti-HIV drugs
Finasteride (Proscar)
Synthetic progesteronemedroxyprogesterone
Changing to a different medication or
different dosage may solve the problem.
Other drugs may affect sex drive, too. If your
sex drive shifted into park soon after
beginning a new medication, talk with your
doctor. Never stop taking a medication
without consulting your doctor.
Sex Drive issue: Poor Body Image
• It's hard to feel sexy if your
self-esteem suffers from
poor body image. For
example, feeling ashamed
of being too heavy (even if
you're not) will douse your
love light. If your partner
has these feelings, it can
really help to reassure him
or her that you still find
him/her sexy. And there's a
flip side to the equation:
Working out not only
enhances your self-esteem,
but also ups your sex drive.
Sex-Drive Issue: Low T
• Testosterone increases sex
drive. As men age, their
testosterone levels may
decline slightly. Not all men
lose the desire for sex when
their testosterone levels drop - but many do. Testosterone is
linked to sex drive in women,
too. But a woman's hormonal
balance is more complex than
a man's. It's not clear whether
testosterone therapy is as safe
and effective in boosting sex
drive for women as it is for
men.
Treatment of Erectile Dysfunction
Definition
“The inability to attain and/ or maintain penile
erection sufficient for satisfactory sexual
performance.”
NIH Consensus Development Panel on Impotence
Goal:
Get an firm erection AND maintain it until orgasm
Good News
• TREATABLE!
• Treat it like a disease
– Life style changes
– Medical treatment
– Surgery
Lifestyle Modifications
• Stop smoking1,2
• Limit or avoid alcohol1
• Follow healthy diet2
• Exercise regularly3
1. Recommendations of the 1st International Consultation on Erectile Dysfunction. In: Jardin A et al, eds. Erectile Dysfunction. Plymouth, UK: Health
Publication, Ltd; 2000:711-726. 2. Feldman HA et al. Prev Med. 2000;30:328-338. 3. Derby CA et al. Urology. 2000;56:302-306.
Medical Treatment:
Vacuum Erection Device
• More accepted by men in a steady relationship
• Don’t use for more than 30 minutes.
Medical Treatment:
Oral Medications
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Increase blood flow to penis (not sexual drive)
Take one hour prior to sex
NEED sexual stimulation
Some people can’t take
– ask your doctor
Penile Injection
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Very effective
Trial in urologist office
Inject penis 10 minutes before sex
Be wary of too much of a good thing: EMERGENCY
Surgical: Penile Prosthesis
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After failure of medical treatment
Inflatable and rigid forms
Sensation the same
Penis may look different
May need to be replaced
Treatment of Female Sexual Dysfunction
Sexual Dysfunction: Male v. Female
Diagnosis
Male
Female
Sexual Dysfunction: Male v. Female
Diagnosis
• Erectile Dysfunction
• Disorder of sexual desire
• Disorder of orgasms
Sexual Dysfunction: Male v. Female
Diagnosis
• Sexual desire disorder
• Disorders of Arousal
– Subjective
– Genital
– Combined
• Disorders of orgasms
• Dyspareunia
– Vestibulodynia
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Hormonally mediated
Neuro-proliferative
– Vaginal
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Atrophic vaginitis
Desquamative inflammatory vaginitis
Interstitial cystitis
Vulvar disorders
– Granuloma fissuratum
– Dermatoses (lichen sclerosis, lichen planus)
Candidiasis
– Hypertonic pelvic floor dysfunction
Treatment of FSD
• Bad news
– Not just blood flow problem
– Complex
– No FDA approved meds
– Studies lag far behind those
for male erectile dysfunction
• Good news
– More and more studies
• physiology of female sexual
function
• Disorders of female sexual
function
– Evidence based treatments
• Early
– Physicians excited about this
new field
Treatment of FSD
Treatment of disorders of desire,
arousal, orgasms
Hormone and neurotransmitters
•Dopamine, oxytocin,
norepinephrine, opioids,
serotonin
Treatment of dyspareunia
Topical creams (eg estrogen)
Pelvic floor rehabilitation
Surgery
•Vestibulectomy
•Sacral nerve implant
Oxytocin – The Love Hormone
• "A study published in the
Bulletin of Experimental
Biology and Medicine
examined the response of
the 'love hormone' oxytocin
on pain perception in an
experiment with 48
volunteers. Study
participants inhaled
oxytocin vapor and then
had their fingers pricked.
Those who had inhaled
oxytocin lowered their pain
threshold by more than
half."
Benefits of Kegel Exercises
• "Kegel exercises have a
number of proven health
benefits in addition to making
sex more enjoyable. The
strengthening of the pelvic
floor muscles can help prevent
prolapse (a slipping out of
position) of the vagina, uterus,
and bladder. Pelvic floor
muscles may be weakened
later in life as a result of
childbearing, being
overweight, and aging. Kegel
exercises help offset the
consequences of weakened
pelvic floor muscles."
Treatment of FSD
Psychosocial aspect and
relationship factors very
important in treatment
Successful treatment
of sexual dysfunction
is treatment of the
couple
Resources
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www.nihseniorhealth.gov
www.aarp.org
www.seniorsite.org
www.americangeriatrics.org
Q&A